Embed Size (px)
criteria for assessing zoological relationships are accepted,it must obviously be concluded that the Australo-
pithecinae are much more closely related to man thanare the modern anthropoid apes. The possibility mustno doubt be considered that their hominid charactersare, so to speak, fortuitous, in the sense that they mightbe the expression of a parallel or convergent evolutionaryprocess. But the resemblances are so numerous, detailed,and intimate, that this interpretation seems far-fetched.Whether the fossils have an ancestral relationship, director indirect, to Homo sapiens can only be finally deter-mined when their geological age is accurately known.The type of the associated fauna has led local pre-historians in South Africa to the general conclusionthat they are probably of Pliocene age ; and, if thisproves to be so, the fossils may well have been repre-sentatives of the ancestral stock which gave rise to theHominidae. If it were shown by further geologicalstudies that they are of more recent date, they could atmost be regarded as late (and apparently little modified)survivors of such an ancestral stock. These seem
reasonable inferences from the data so far available, andfrom the strictly anatomical point of view there appearsto be nothing to preclude an ancestral relationship.Some of those who have studied the australopithecine
fossils have expressed doubt whether they should beregarded as a very progressive type of ape or an exceed-ingly primitive type of man. This doubt is readily under-stood when the anatomical details of the skull, dentition,and limb-bones are considered in detail one by one. Dr.Broom refers to these creatures as " ape-men," and thisgeneral and non-committal term has much in its favour.In his discourse at the Zoological Society, ProfessorLe Gros Clark suggested that, in view of the relativesize and proportions of the brain, it might be desirable(pending the further evidence which is now accumulating)to adopt a conservative attitude by calling them apesrather than ape-men. He also urged that final and
emphatic statements about their relation to the originof man should be avoided for the present, since the dis-coveries during the last few weeks, and those likelyto be made in the near future, will certainly yield muchmore information.
EDINBURGH AS POSTGRADUATE CENTRE
As might be expected from its ancient teachingtradition, Edinburgh is not lagging in its organisation ofpostgraduate education. In the last few years greatdifficulties have been surmounted ; and the recentappointment of Major-General Sir Alexander Biggam,late consulting physician to the Army, as director ofpostgraduate studies, reflects the importance attachedto further development in this sphere. The criticismthat the Royal Infirmary contains too few patients forthe proper training of postgraduates, in addition to
large undergraduate needs, is more than ever valid inthe present post-war rush. The Edinburgh Post-GraduateBoard for Medicine has therefore looked elsewhere forits clinical material ; and students are conveyed to thethree large municipal hospitals, to special hospitals,and to the Royal Infirmary’s rehabilitation centre.These are situated within easy reach, so little time is
spent on the journeys. With sections of classes visitingthese centres in rotation, the experience is wider thanwould be obtained by continuous instruction in the samegeneral hospital ; and the presence of postgraduatestudents in the various hospitals provides an additionalstimulus to the staffs. The eventual aim is to establisha separate school for postgraduates, physically near to,but administratively independent of, the Royal Infirmary.There is little hope of new building within the nextdecade, but as an expedient the use of one of the smallerexisting hospitals in the city would temporarily meetthis need. At present the board is conducting shortrefresher courses and four long courses per year-two
in internal medicine and two in general surgery. Applica-tions for enrolment far exceed vacancies, and selection ofcandidates according to qualifications and experience ismade.
Edinburgh was always known as a gathering-point foroverseas students, and the present postgraduate classescontain an ever-increasing number of graduates fromSouth Africa, Canada, India, and other parts of the world.Undoubtedly some Dominion visitors, particularly thosefrom Australia and New Zealand, who formerly camein large numbers, are deterred by the fear that theymay not find accommodation. The board helps, where itcan, by passing on the addresses of recommended
lodgings and private hotels ; but their number is ofteninsufficient, and the authorities are seeking to buy abuilding capable of housing 80-100 students. Theuniversity must now be regretting that it did not take,or was not offered, the chance of purchasing the housesof University Hall-formerly run, principally for under-graduates, by the Town and Gown Association-whichwere sold at the end of the war.Most other medical schools will acknowledge their
debt to Edinburgh’s example in the arrangement ofsystematic teaching, and they will still find novelties.For example postgraduate students are asked, at theend of each course, for their frank criticism of thearrangements for their instruction, and many of theirproposals have been incorporated in the programmes ofthe classes.
THE Cancer Act of 1939 is now superseded by theNational Health Service Act of 1946, and most of itsprovisions will be carried out by the new regional boards.The Radium Commission strongly urge that everyregion should have a cancer organisation, under the
wing of the regional board, to help in planning cancertreatment. From their long experience they suggestthat this organisation should see that there are facilitiesfor early diagnosis, treatment by trained specialists,follow-up, records, and research, and should make surethat these facilities are fully used by all concerned.The many difficulties to be overcome include lack of
specialists (both surgeons and radiotherapists), and
inadequacy of buildings and equipment, while furtherresearch will be needed to exploit recent discoveries innuclear physics. The reports from the various centresindicate how some of these difficulties may be overcome,but through every report runs the same story-newbuilding is essential.. Birmingham has produced acancer scheme for the West Midlands, but this dependson the opening of a new block at the Queen ElizabethHospital, for which an
" licence has not been obtained.Leeds is seeking authority to add a new block to thepresent X-ray department., Liverpool must erect tempo-rary accommodation. - Newcastle has to treat patientsin three hospitals, one at a considerable distance, whichis extravagant both in the time of the specialist staffand in the use of specialist equipment. Manchester isfortunate in having obtained a licence to add an addi-tional story to a ward block, but this must be followedby further building to make room for necessary equip-ment and services. It is easy to see how centres facedwith so many obstacles can be helped by an advisorybody, such as the Radium Commission. The evolutionof specialist services for cancer can be properly con-trolled only if expert opinion is to be had when difficultdecisions must be made.The work done by the technical committee is also
important. Large quantities of radium have been turnedover by the Radium Trust for the increasing work of thecommission’s centres, and though there is still a bottle-neck in the making and filling of containers, radium is1. 17th Annual Reports of the National Radium Trust and Radium
Commission. 1945-46. Cmd. 7127. H.M. Stationery Office.Pp. 28. 6d.
gradually reaching the centres and enabling cliniciansto try new methods of treatment. Particulars of thenew types of container which have been measured andaccepted during the year 1945-46 are given in an appendixto the commission’s report-a valuable list of the
approved types which will be helpful to hospitals whenordering new radium. The use of radon is also beingbrought under control. Under an arrangement with theMedical Research Council the radon centre at Bartonissues radon only to hospitals which have been approvedby the commission, and such approval is given only tothose hospitals which have a radiotherapeutic depart-ment properly organised and equipped, and where theuse of radon is suitably supervised. -
PLANS OF THE R.M.B.F.
Westmoreland Lodge, the home for old peoplesponsored by the Royal Medical Benevolent Fund, is
nearing its date of opening. In his report on theR.M.B.F.’s work presented to the annual general meetingon June 5, Mr. R. Handfield-Jones, F.R.C.S., spoke ofthis project as particularly dear to Sir Arnold Lawson,the late president, who before he died was able to ensurethat a suitable house had been bought. This stands inits own grounds near Wimbledon Common, convenientlyplaced for bus routes to Wimbledon and Putney. It willcontain enough single-room flats to receive twelve
elderly ladies capable of looking after themselves, doingtheir own shopping, and cooking their own breakfast,tea, and supper. Midday dinner will be provided at avery low cost and served in the common dining-roomand lounge. Residents will be independent, living withtheir own furniture round them, but the fund will supplycentral heating, hot and cold water, a gas or electricfire, and a gas-ring in each bed-sitting-room. Thehouse has cost f:7000, and repairs and alterations areestimated at a further 5000. Annual expenses willinclude rates, wages, garden, insurance, light, and heat.
If Westmoreland Lodge proves a success the managersof the fund hope to open another home, possibly forelderly men, or possibly for the sick who need nursing.Meanwhile the undertaking has called for courage, andMr. Handfield-Jones trusts that it will be cordiallysupported. The council of the British Medical Associa-tion have allocated E200 to it, and Mr. Handfield-Jonesasks all the fund’s subscribers, when sending theirannual subscriptions, to add a special additional chequeor banker’s order marked " Westmoreland Lodge."The profession should look after its own, when they fallon evil times, and he is confident they would resentoutside assistance, in spite of the many opportunitiesof appealing to the general public which offer fromtime to time. He asks that, besides giving himself,every subscriber should enlist another during the year.At the annual meeting Sir Alfred Webb-Johnson,was elected to succeed Sir Arnold Lawson aspresident. Dr. C. L. Batteson will remain treasurer,and Mr. V. H. Riddell, F.R.C.S., succeeds Mr. Handfield-Jones as hon. secretary.
PRESIDENT TRUMAN AND NATIONAL INSURANCE
ON May 19 President Truman in a special messageasked the United States Congress to give " immediateattention " to the question of enacting a national healthprogramme to assure that " the opportunity for goodhealth be made available to aP, regardless of residence,race, or economic status." He stated that in November,1945, he had in a message to the last Congress outlineda long-range health services plan, and that certainadvances in the directions he then indicated had beenmade ; but he urged the need for further effort to
provide : (1) adequate public health services ; (2) addi-tional facilities for medical research and medical educa-tion ; (3) more hospitals, and more doctors, dentists,
and nurses ; (4) insurance against costs of medical care ;and (5) protection against loss of earnings during sickness.He laid special stress on the need for further researchin the prevention and cure of disease, and for expandededucational facilities to meet the shortage of medical
personnel, which is now severely felt, particularly in therural areas, and would, he said, " continue to plaguethe nation until means are found to finance modernmedical care for all of our people." The main conclusionto which Mr. Truman’s review of the situation leadshim is that " national health insurance is the mosteffective single way to meet the nation’s health needs.Hitherto the American advocates of national healthinsurance have encountered formidable oppositionfrom influential quarters-notably from the AmericanMedical Association-and they appear to have achievedbut little success in their efforts to secure legislation tocarry their prospects into effect. But during Mr.Roosevelt’s long period of office compulsory insuranceagainst unemployment and old age was introducedand met with general acceptance, and it seems possiblethat familiarity with the practical working of theseforms of social security may have removed much ofthe hostility to the form of social security that providesmedical care through national insurance. In his latest
message Mr. Truman states that he regards healthinsurance as " a logical extension of the present socialsecurity system which is so firmly entrenched in our
American democracy " ; and he concludes :" The total health programme which I have proposed is
crucial to our national welfare. The heart of that pro-gramme is national health insurance. Until it is a part ofour national fabric, we shall be wasting our most preciousnational resource and shall be perpetuating unnecessarymisery and human suffering."
REMUNERATION OF SPECIALISTS
SOME time ago the Minister of Health and the Secretaryof State for Scotland appointed a committee torecommend " what ought to be the range of total
professional remuneration of registered medical practi-tioners engaged in the different branches of consultantor specialist practice in any publicly organised hospitaland specialist service." The membership of the com-mittee has now been announced as follows :
Sir WILL SPENS (chairman), Mr. C. R. DALE, Sir TnoMAsGARDINER, Mr. T. LISTER, Miss ELIZABETH LOOKER, Prof. D.MURRAYLYON, F.R.C.P.E., Lord MORAN, P.R.C.P., Mr. LESLIE E.PEPPIATT, Prof. HARRY PLATT, F.R.C.S., Dr. S. COCHRANESHANKS, F.F.R., Mr. J. R. H. TURTON, F.R.C.S., with Mr.T. B. WILLIAMSON (Ministry of Health) and Dr. D. P.STEVENSON (assistant secretary, British Medical Association)as joint secretaries.
THREE MONTHS’ POSTPONEMENT
THE day appointed for starting the National HealthService and the related schemes of social insurancehas been changed from April 1 to July 5, 1948. In hisstatement last Monday the Prime Minister pointedout that " the various schemes are closely linked upwith each other and with proposals for completing thebreak-up of the poor-law, and providing a comprehensivescheme of national assistance, standing behind theinsurance provisions." A Bill to end the poor-law willbe introduced next session, so that all the schemescan be brought into operation on the same day.
WE regret to announce the death of Mr. JogCROWLESMITH who retired last year from the board ofdirectors of Messrs. Hazell, Watson & Viney, printers ofTHE LANCET. Eighty-six years of age, he joined thefirm in 1882, and for the last 25 of his 64 years’ servicehe was our valued associate in the production of thisjournal. He held office as president both of the LondonMaster Printers’ Association and of the British Federa-tion of Master Printers, and he leaves happy recollectionswith all who worked with him.